Reference-Based Price Report

Commercial health insurance payers often negotiate rates with facilities and providers based on discounts from charges. However, some payers and employer purchasers are starting to explore using Medicare rates and median commercial payments in their negotiations for health care services in order to control spending. This report shows how prices for high volume services in Colorado compare to both Medicare and median commercial payments.

Considerations

When viewing this report, keep in mind:

  • This report shows commercial payments compared to Medicare and statewide commercial medians for common procedures in three categories: Hospital Procedures (services requiring an overnight stay); Other procedures (services not requiring an overnight stay); and Office Visits (services paid to a health care provider in the office setting).
  • Prices reflect the amount paid for services to facilities (Hospital Procedures and Other Procedures) and providers (Office Visits Tab) by both health insurance companies and patients (member liability) combined. Hospital Procedures and Other Procedures only include the facility payment and do not include any ancillary or provider payments.
  • Prices do not include any premiums paid and do not reflect what it costs the provider to deliver care.

Reference-Based Price Report